Tuesday, February 10, 2009

Will A national coordinator of health information technology jump start the economy?

The first I read about the post of National Coordinator of Health Information technology (NCHIT) as being part of the stimulus package was in this commentary by Betsy McCaughey.

Reference to the relevant sections of the bill can be found in McCaughey's article in Bloomberg. including a description of the duties and powers of this office as outlined in one version of the House stimulus bill. Actually, this office already exists as shown here ,it is the expansion of a program headed by this office that is contained in the House Bill and so far seems to escaped much scrutiny.

The provisions as described by Ms.McCaughey,if accurately depicted, should be of concern to anyone old enough to be a member of AARP as it looks like the old folks will get screwed first. My attempts to verify Ms. McCaughey's comments by referring to the bill's language itself have not been successful. There are hundreds of pages of the type dense statutory prose that send the reader back and forth to various internal references.I will repeat some of her comments regarding the bill with the caveat that they are her comments and I have not been able to confirm their accuracy.

One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.” .......

Hospitals and doctors that are not “meaningful users” of the new system will face penalties. “Meaningful user” isn’t defined in the bill. That will be left to the HHS secretary, who will be empowered to impose “more stringent measures of meaningful use over time” (511, 518, 540-541)

What penalties will deter your doctor from going beyond the electronically delivered protocols when your condition is atypical or you need an experimental treatment? The vagueness is intentional. In his book, Daschle proposed an appointed body with vast powers to make the “tough” decisions elected politicians won’t make.

It looks like Mr. Daschle,though no longer to be the czar of health care reform, will leave his imprint in the language of the bill which according to the Bloomberg article resonates with the ideas and plans outlined in the former senator's book.

MedInformaticsMD writing on the blog HealthCare Renewal also quotes the Bloomberg article but expresses in convincing detail another issue with the plan. That issue , simply put is that when governments have attempted to pull off an IT system of that complexity is that they will very likely screw it really badly and may never finish and he gives examples.

Whether it be considered as a Trojan horse to sneak in socialized medicine,a gigantic boondoggle that will have never ending cost overruns and myriad unintended consequences,or an important circuit in the electrified apparatus to jump start the economy, many would feel better about it if it could approached in the open with public comment and committee hearings rather than being rushed past Congress with warnings of the dire consequences of delay.

Also see my academic website "Common examples of healthcare IT difficulty" here. I and a number of other experts in medical informatics, computer science, sociology and other fields have been writing about these problems for a decade.

This is actually true, because my cousin had a similar problem last year. He was lucky enough that before this addiction had gotten worse, he was treated properly in a seattle urgent care clinic. The doctor gave him proper medication and therapy for him to stop his addiction.